Medical device delivery system with locking system

ABSTRACT

Medical device delivery system including a catheter, handle, lock line handle, and lock line. The catheter includes a proximal end portion and a distal end portion. The handle is coupled to the proximal end portion of the catheter. The lock line handle is releasably coupled to the handle and actuatable between a lock position and an unlock position. The lock line includes a first end portion fixedly coupled to the lock line handle, a second end portion releasably coupled to the lock line handle, and an intermediate portion configured to be releasably coupled to the medical implant disposed proximate the distal end portion of the catheter. Actuating the lock line handle from the lock position toward the unlock position increases tension on the lock line, and actuating the lock line handle from the unlock position toward the lock position decreases tension on the lock line.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.17/091,881, filed Nov. 6, 2020, which claims priority to U.S.Provisional Application No. 62/932,794, filed Nov. 8, 2019, the fulldisclosures of which are incorporated herein by reference in theirentireties.

BACKGROUND Field of Disclosed Subject Matter

The disclosed subject matter is directed to medical devices forendovascular, percutaneous or minimally invasive surgical treatment ofbodily tissues, such as tissue approximation or valve repair. Moreparticularly, the present disclosure relates to repair of valves of theheart and venous valves.

Surgical repair of bodily tissues can involve tissue approximation andfastening of such tissues in the approximated arrangement. Whenrepairing valves, tissue approximation includes coapting the leaflets ofthe valve in a therapeutic arrangement which can then be maintained byfastening or fixing the leaflets. Such coaptation can be used to treatregurgitation, which commonly occurs in the mitral valve and in thetricuspid valve.

Mitral valve regurgitation is characterized by retrograde flow from theleft ventricle of the heart through an incompetent mitral valve into theleft atrium. During a normal cycle of heart contraction (systole), themitral valve acts as a check valve to prevent flow of oxygenated bloodfrom the left ventricle back into the left atrium. As such, as the leftventricle contracts, the oxygenated blood is pumped from the leftventricle into the aorta through the aortic valve. Regurgitation of themitral valve can significantly decrease the pumping efficiency of theheart, placing the patient at risk of severe, progressive heart failure.

Mitral valve regurgitation can result from a number of differentmechanical defects in the mitral valve or the left ventricular wall. Thevalve leaflets, the valve chordae connecting the leaflets to thepapillary muscles, the papillary muscles, or the left ventricular wallcan be damaged or otherwise dysfunctional. Commonly, the valve annuluscan be damaged, dilated, or weakened, limiting the ability of the mitralvalve to close adequately against the high pressures of the leftventricle.

Description of Related Art

Treatments for mitral valve regurgitation can involve valve replacementor repair including leaflet and annulus remodeling, the latter generallyreferred to as valve annuloplasty. Another technique for mitral valverepair, which can be referred to as the “bow-tie” or “edge-to-edge”technique, can involve suturing adjacent segments of the opposed valveleaflets together. Preferably, devices and systems for mitral valverepair can be utilized without open chest access, and, rather, can becapable of being performed endovascularly, i.e., delivering fixationdevices (e.g., a valve repair clip) using delivery systems advanced tothe heart from a point in the patient's vasculature remote from theheart. During endovascular procedures, the fixation devices delivered tothe heart can be operated remotely (i.e., from outside the patient'sbody), for example, the fixation devices can be opened and closed.Additionally, the devices and systems can typically lock the fixationdevice into a fixed position and unlock the fixation device to allowrepositioning (and/or removal if desired), for example, using a lockline extending from the handle (i.e., outside the patient) to thefixation device. Once the tissue has been satisfactorily approximated,the fixation system can be left behind as an implant. As such, thereremains a need for ergonomic control of the lock line and release of thelock line to leave the fixation device behind for implantation.

SUMMARY

The purpose and advantages of the disclosed subject matter will be setforth in and apparent from the description that follows, as well as willbe learned by practice of the disclosed subject matter. Additionaladvantages of the disclosed subject matter will be realized and attainedby the systems and methods particularly pointed out in the writtendescription and claims hereof, as well as from the appended drawings.

To achieve these and other advantages and in accordance with the purposeof the disclosed subject matter, as embodied and broadly described, thedisclosed subject matter is directed to a medical delivery systemincluding a locking system.

In accordance with the disclosed subject matter, a medical deliverydevice system for delivering a medical implant is provided. The medicaldevice delivery system includes a catheter, handle, lock line handle,and lock line. The catheter includes a proximal end portion and a distalend portion. The handle is coupled to the proximal end portion of thecatheter. The lock line handle is releasably coupled to the handle andactuatable between a lock position and an unlock position. The lock lineincludes a first end portion fixedly coupled to the lock line handle, asecond end portion releasably coupled to the lock line handle, and anintermediate portion configured to be releasably coupled to the medicalimplant disposed proximate the distal end portion of the catheter.Actuating the lock line handle from the lock position toward the unlockposition increases tension on the lock line, and actuating the lock linehandle from the unlock position toward the lock position decreasestension on the lock line.

In accordance with the disclosed subject matter, the system can includea lock assembly to selectively secure the lock line handle in each ofthe lock position and unlock position. The lock assembly can include atleast one of audible and tactile feedback upon locking. The lockassembly can include a latch-detent lock. The latch of the latch-detentlock can be spring-biased towards a lock position.

In accordance with the disclosed subject matter, the lock line handlecan be configured to pivot relative the handle to actuate between thelock position and the unlock position. The lock line handle can includea spool to receive the lock line. The first end portion of the lock linecan be coupled to the lock line handle by a swivel-head set screw. Thelock line handle can include a pear shape. The lock line handle can bereleasably coupled to the handle by one of a snap fit, clip,slide-release, and button-release.

The lock line handle can be configured to translate linearly relativethe handle to actuate between the lock position and the unlock position.The lock position can be located distally from the proximal position.The lock line handle can include a T-shape. The lock line handle caninclude a thumb slide.

The lock line handle can be actuatable from the unlock position toward athird position to further increase tension on the lock line beyond thetension on the lock line in the unlock position. The system can includean override mechanism to selectively prevent activation of the lock linehandle from the unlock position to the third position. The second endportion of the lock line is configured to be release when the lock linehandle is released from the handle

In accordance with the disclosed subject matter, the catheter can defineat least one lumen extending between the proximal end portion and thedistal end portion. The system can include a shaft having a proximal endportion and a distal end portion, and the shaft can extend through theat least one lumen. The medical implant can be releasably coupled to thedistal end portion of the shaft. The system can include an outercatheter having a proximal end portion coupled to the handle and adistal end portion, the outer catheter defining at least oneouter-catheter lumen extending between the proximal end portion and thedistal end portion; wherein the catheter extends through theouter-catheter lumen.

The medical implant can be an implantable fixation device. Theimplantable fixation device can include a first arm moveable between afirst position and a second position, and a second arm moveable betweena first position and a second position. When the lock line handle is inthe lock position the first arm and the second arm can be restricted atleast from moving from the respective first positions toward therespective second positions. When the lock line handle is in the lockposition the first arm and the second arm can move from the respectivesecond positions toward the respective first positions. When the lockline handle is in the unlock position the first arm and the second armcan be moved freely between the respective first positions and secondpositions. The implantable fixation device can include a first grippingelement movable relative to the first arm; and a second gripping elementmovable relative to the second arm.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is perspective view of an exemplary embodiment of a fixationdevice for use in accordance with the disclosed subject matter.

FIG. 2 is side view of a locking system of a fixation device, inaccordance with the disclosed subject matter.

FIG. 3 is a perspective view of the binding plate of the locking systemof FIG. 2 .

FIG. 4 is an enlarged detail view of a portion of the locking system ofFIG. 2 .

FIG. 5 is a perspective view of an exemplary embodiment of a deliverydevice for use in accordance with the disclosed subject matter.

FIG. 6 is an enlarged view of the handle of the delivery device of FIG.5 .

FIG. 7 is a cut-away view of the handle of FIG. 6 .

FIG. 8 is an enlarged view of a handle including a lock line handle inaccordance with the disclosed subject matter.

FIG. 9 is a cut-away view of the handle of FIG. 8 .

FIG. 10 is a perspective view of the lock line handle and certainfeatures of the handle of FIG. 6 .

FIG. 11 is an exploded view of the lock line handle and certain featuresof the handle of FIG. 6 .

FIG. 12 is a perspective view of the lock line handle and certainfeatures of the handle of FIG. 6 .

FIG. 13A is a cut away view of certain features of the lock line handleand handle of FIG. 6 .

FIGS. 13B and 13C are perspective views of certain features of a lockline handle and handle, in accordance with the disclosed subject matter.

FIG. 14 is a perspective view of the lock line handle in the lockposition and certain features of the handle of FIG. 6 .

FIG. 15 is a perspective view of the lock line handle in the unlockposition and certain features of the handle of FIG. 6 .

FIG. 16 is a perspective view of the lock line handle in the thirdposition and certain features of the handle of FIG. 6 .

FIGS. 17A and 17B are perspective views of the lock line handle andcertain features of the handle of FIG. 6 , including the release sliderpulled to a proximal position.

FIG. 18 is a perspective view of the lock line handle and certainfeatures of the handle of FIG. 6 , with the lock line handle removed.

FIG. 19 is a perspective view of a disassembled lock line handle andcertain features of the handle of FIG. 6 .

FIG. 20 is a perspective view of a handle, including a slider lock linehandle, in accordance with the disclosed subject matter.

FIGS. 21A-C are enlarged detail views of the slider lock line handle ofFIG. 20 .

FIGS. 22A-C are enlarged detail views of embodiments of slider lock linehandles in accordance with the disclosed subject matter.

FIG. 23 is a perspective view of handle, including a T-shape lock linehandle, in accordance with the disclosed subject matter.

FIG. 24 is a perspective view of a handle, including a pivotable lockline handle, in accordance with the disclosed subject matter.

FIG. 25A is a perspective view of a pivotable lock line handle in thelock position, in accordance with the disclosed subject matter.

FIG. 25B is a perspective view of the pivotable lock line handle of FIG.25A in the unlock position.

FIGS. 26A-B are perspective views of the lock line handle of FIG. 25A inthe unlock position and third position, respectively.

FIGS. 27A-B are perspective views of the lock line handle of FIG. 25Abeing released from the handle.

FIGS. 28A-B are cut-away views of the lock line handle of FIG. 25A.

FIG. 29A is a perspective view of a spool and shaft of the lock linehandle of FIG. 25A.

FIG. 29B is an exploded view of the spool and shaft of FIG. 29A.

FIG. 30 is a cut-away view of a spool and swivel-head set screw of thelock line handle of FIG. 25A.

FIGS. 31A-B are perspective views of a lock line handle in accordancewith the disclosed subject matter.

FIGS. 31C-D are cut-away views of the lock line handle of FIG. 31A.

FIGS. 32A-C are cut-away views of the lock line handle of FIG. 31A.

FIG. 33 is a perspective view of the lock line handle of FIG. 31A.

FIG. 34 is a perspective view of an exemplary embodiment of a deliverysystem in accordance with the disclosed subject matter.

FIG. 35 is an enlarged perspective view of a portion of the exemplaryembodiment of a delivery system in accordance with the disclosed subjectmatter.

DETAILED DESCRIPTION

Reference will now be made in detail to the various exemplaryembodiments of the disclosed subject matter, exemplary embodiments ofwhich are illustrated in the accompanying drawings.

Generally, and as set forth in greater detail below, the disclosedsubject matter provided herein includes a medical device delivery systemfor delivering a medical implant, such as a fixation device. The medicaldevice delivery system includes a catheter, handle, lock line handle,and lock line. The catheter includes a proximal end portion and a distalend portion. The handle is coupled to the proximal end portion of thecatheter. The lock line handle is releasably coupled to the handle andactuatable between a lock position and an unlock position. The lock lineincludes a first end portion fixedly coupled to the lock line handle, asecond end portion releasably coupled to the lock line handle, and anintermediate portion configured to be releasably coupled to the medicalimplant disposed proximate the distal end portion of the catheter.Actuating the lock line handle from the lock position toward the unlockposition increases tension on the lock line, and actuating the lock linehandle from the unlock position toward the lock position decreasestension on the lock line.

The medical device delivery system of the disclosed subject matter canbe used for edge-to-edge transcatheter valve repair for patients havingvarious conditions, including regurgitant mitral valves or tricuspidvalves. Although described with respect to edge-to-edge repair, themedical device delivery system of the disclosed subject matter can beused with a wide variety of suitable transcatheter delivery systems.Transcatheter (e.g., trans-septal) edge-to-edge valve repair has beenestablished using a fixation device, such as the MitraClip TranscatheterMitral Valve Repair device. These fixation devices generally areconfigured to capture and secure opposing native leaflets using twotypes of leaflet contacting elements. The first element is asub-valvular arm (also known as a distal element or fixation element) tocontact the ventricular side of a native leaflet to be grasped. With thearm positioned underneath to stabilize the native leaflet in a beatingheart, a second gripping element (also known as a proximal element) canbe lowered or moved into contact with the atrial side of the nativeleaflet to capture the leaflet therebetween. Once each opposing leafletis captured by a respective arm and gripper element, the fixation devicecan be closed by moving the arms toward a center of the fixation devicesuch that the leaflets are brought into coaptation, which results in areduction in valvular regurgitation during ventricular systole.Furthermore, a covering can be provided on the arms and/or gripperelements to facilitate tissue ingrowth with the captured leaflets. Suchfixation devices can be delivered to the mitral valve using a deliverysystem. The delivery system can include control features including,among other things, a locking feature for allowing or inhibiting motionof the distal elements.

Additional details of exemplary fixation devices and delivery systems inaccordance with the disclosed subject matter are set forth below.Furthermore, various patents and published applications discloseadditional details of such fixation devices and delivery systems andrelated operations, for example, U.S. Pat. No. 7,226,467 to Lucatero etal., U.S. Pat. No. 7,563,267 to Goldfarb et al., U.S. Pat. No. 7,655,015to Goldfarb et al., U.S. Pat. No. 7,736,388 to Goldfarb et al., U.S.Pat. No. 7,811,296 to Goldfarb et al., U.S. Pat. No. 8,057,493 toGoldfarb et al., U.S. Pat. No. 8,303,608 to Goldfarb et al., U.S. Pat.No. 8,343,174 to Goldfarb et al., U.S. Pat. No. 8,500,761 to Goldfarb etal., U.S. Pat. No. 8,734,505 to Goldfarb et al., U.S. Pat. No. 8,740,920to Goldfarb et al., U.S. Pat. No. 9,510,829 to Goldfarb et al., U.S.Pat. No. 7,635,329 to Goldfarb et al., U.S. Pat. No. 8,945,177 to Dellet al., U.S. Pat. No. 9,011,468 to Ketai et al., U.S. Patent ApplicationPublication No. 2017/0042546 to Goldfarb et al., U.S. Patent ApplicationPublication No. 2017/0239048 to Goldfarb et al., U.S. Patent ApplicationPublication No. 2018/0325671 to Abunassar et al., U.S. application Ser.No. 16/930,241 to Kizuka, and U.S. application Ser. No. 16/930,224 toChilds, the entirety of the contents of each of these patents andapplications is incorporated herein by reference.

Referring to FIG. 1 for purpose of illustration and not limitation, anexemplary fixation device 14 for fixation of native leaflets of a heartvalve is disclosed herein. The fixation device as depicted can includeat least gripping elements 16 and arms 18 which can protrude radiallyoutward and can be positionable on opposite sides of tissue, such asleaflets, so as to capture or retain the leaflets therebetween at asingle location or along a continuum or range of positions as desired bythe user. The gripping elements 16 can be manipulated by grippingelement lines 90A, 90B. That is, the gripping elements 16 can be raisedand lowered by increasing or decreasing tension on the gripping elementlines 90A, 90B. The fixation device 14 is couplable to the shaft of adelivery system (not shown) by a coupling mechanism, a portion of whichis shown as coupling member 19. Although a specific arrangement ofgripping element lines 90A, 90B, is shown, any suitable arrangement canbe used. For example, a single gripping element line manipulate grippingelement 16. The coupling mechanism can allow the fixation device 14 todetach and be left behind as an implant to hold the leaflets together inthe coapted position. The coupling member 19 can be formed with orconnected to housing 4, which can house locking mechanism 106.

The fixation device 14 can include a locking mechanism 106 for lockingthe device 14 in a particular position, such as an open, closed, orinverted position, or any position therebetween. In accordance with thedisclosed subject matter, the locking mechanism 106 can include anunlocking mechanism which can allow the device to be both locked andunlocked. The locking mechanism 106 can be disposed between the couplingmember 19 and the base 69 of the actuation mechanism 58. The base 69 canbe connected to the legs 68 of the actuation mechanism 58 which can beconnected to arms 18. Thus, movement of the legs 68 can move the arms 18through open, closed and inverted positions. The base 69 can also befixedly attached to stud 74 which can extend through the lockingmechanism 106. The stud 74 can be releasably attached to an actuator rod64 which passes through coupling member 19 and the shaft of the deliverysystem. Release of the stud 74 from the actuator rod 64 allows thefixation device 14 to be detached and left behind as an implant.

Lock line 92 is connected with release harness 108 of the lockingmechanism 106. The lock line 92 can lock and unlock the lockingmechanism 106 as described in greater detail below. The gripping elementlines 90A, 90B and lock line 92 can be any suitable material, includingwire, nitinol wire, cable, suture or thread. Additionally, grippingelement lines 90A, 90B and/or lock line 92 can includes a coating, suchas a Parylene®. Parylene® is a vapor deposited pinhole free protectivefilm which is conformal and biocompatible. It is inert and can protectagainst moisture, chemicals, and electrical charge.

Referring to FIGS. 2-4 for purpose of illustration and not limitation,an exemplary locking mechanism 106 is provided. The locking mechanism106 can include a binding lever or binding plate 450. As shown in FIG. 3, for purpose of illustration and not limitation, binding plate 450 canhave an oblong shape extending between a first end 452 and a second end454 with a bottom planar surface 456 and a top planar surface 458. Anaperture 460 can be formed between the first end 452 and second end 454extending from the top planar surface 458 through to the bottom planarsurface 456. The binding plate 450 can be positioned within the lockingmechanism 106 so that the stud 74 passes through the aperture 460. Thefirst end 452 can be positioned within a notch 462 which can preventaxial movement of the first end 452. However, the second end 454 can befree to move in an axial direction, thereby creating a lever typemovement of the binding plate 450. Movement of the second end 454 can becontrolled by the associated hooked end 112 of the release harness 108.When an upwards force is applied to the harness 108 by the lock line 92,the hooked end 112 raises the second end 454 of the plate 450 against aspring 114 so that the planar surfaces 456, 458 are substantiallyperpendicular to the stud 74. This aligns the aperture 460 with the stud74 allowing free movement of the stud 74. Thus in this state, thelocking mechanism 106 is unlocked wherein the stud 74 is free to movethe actuation mechanism 58 and therefore the arms 18 to any desiredposition.

Release of the harness 108 by the lock line 92 can transition thelocking mechanism 106 to a lock position. By releasing the upwards forceon the second end 452 of the binding plate 450, the spring 114 can forcethe second end 452 downwards and can wedge the aperture 460 against thestud 74. This can restrict motion of the stud 74, which in turn can lockthe actuation mechanism 58 and therefore arms 18 in place. Binding plate450 can have any suitable form to function as described hereinabove. Forexample, the plate 450 can include a variety of shapes with or withoutplanar surfaces 456, 458 and/or aperture 460 can be of a variety ofshapes and positioned in a variety of locations. Further, any number ofbinding plates 450 can be present. Each binding plate 450 can provide anadditional biding location which can enhance lock performance.

Although this disclosures describes specific designs for the bindingplate 450, any suitable binding plate 450 is contemplated. For example,the binding plate 450 can be shaped without an aperture 460. In suchembodiments, the binding plate 450 can be shaped to at least partiallysurround the stud 74, such as having a notch, inlet or hook-shapethrough which the stud 74 can pass. Thus, the binding plate 450 canfunction in the same manner as described above wherein the portion atleast partially surrounding the stud 74 can engages the stud 74 forlocking and disengages the stud 74 for unlocking.

The biding plate 450 and the stud 74 can be any suitable materials. Forexample, binding plate 450 can have a higher hardness than the stud 74.Alternatively, binding plate 450 can include a flexible or semi-flexiblematerial. Such flexibility can allow a slight movement of the stud 74 inthe proximal and distal directions, therefore allowing slight movementof the arms 18 when the locking mechanism is in the lock position.Although this application This can allow the fixation device 14 o adjustin response to dynamic cardiac forces.

Locking mechanism 106 can allow the fixation device 14 to beincrementally moved toward the closed position while locked. Movementtoward the closed position is achieved by retracting or pulling the stud74 in the proximal direction so that the arms 18 approach each other.Retraction of the stud 74 draws the binding plate 450 toward ahorizontal position, aligning the aperture with the stud 74 and thusallowing movement. In contrast, extension or pushing of stud 74 in thedistal direction can be resisted by further wedging the binding plate450 against the stud 74. Once the final placement is determined, thelock line 92 and proximal element lines 90A, 90B can be removed and thefixation device can be left behind. Although this disclosure describesspecific designs for the lock mechanism, any suitable lock mechanism iscontemplated. Additional details and exemplary locking mechanisms areprovided in U.S. Pat. No. 8,343,174 to Goldfarb et al., the entirety ofthe contents of which is incorporated herein by reference.

Referring to FIG. 5 for purpose of illustration and not limitation, anexemplary delivery device 300 is provided for delivery of a fixationdevice as disclosed. That is, the delivery device 300 can be used tointroduce and position a fixation device as described above. Thedelivery device 300 can include a shaft 302, having a proximal end 322and a distal end 324, and a handle 304 attached to the proximal end 322.A fixation device (not shown) can be removably coupleable to the distalend 324 for delivery to a site within the body, for example, the mitralvalve. Thus, extending from the distal end 324 is a coupling structure320 for coupling with a fixation device 104. Also extending from thedistal end 324 is an actuator rod 64. The actuator rod 64 is connectablewith the fixation device 14, for example to stud 74, and can act tomanipulate the fixation device 14, for example, opening and closing thearms 18. Handle 304 of the delivery device 300 is shown, including mainbody 308, proximal element line handle 312, the lock line handle 310,the actuator rod control 314 and the actuator rod handle 316, amongother features. The handle 304 is supported by the support base 306which is connected to handle 1057 (see FIG. 35 ).

Lock line (or lines) 92 can pass through at least one lumen of shaft 302between the lock line handle 310 and the locking mechanism 106. The lockline 92 can engage the release harness 108 of the locking mechanism 106to lock and unlock the locking mechanism 106 as described above. Thelock line 92 can engage the release harness 108 in various arrangements,for example, as shown in FIG. 1 . Additional details and exemplary lockline coupling with the fixation device 14 is provided in U.S. Pat. No.7,563,267 to Goldfarb et al., the entirety of the contents of which isincorporated herein by reference.

Referring to FIGS. 6 and 7 for purpose of illustration and notlimitation, actuator rod handle 316, actuator rod control 314, grippingelement line handle 312, and lock line handle 310 can all be joined withthe main body 318 of handle 304. The handle 304 can include a supportbase 306 connected with the main body 308. The main body 308 can beslidable along the support base 306 to provide translation of the shaft302 and the main body 308 is rotateable around the support base 306 torotate the shaft 302.

FIG. 7 provides a partial cross-sectional view of body 308 of the handle304 depicted in FIG. 6 . As shown in FIG. 7 , the main body 308 caninclude a sealed chamber 370 within which the actuator rod 64, grippingelement lines 90A, 90B, and lock line 92 can be guided into the shaft302. The sealed chamber 370 can be in fluid communication with the innerlumen of the shaft 302 and can be filed with saline and flushed withheparin or heparinized saline. The sealed chamber 370 can have a seal372 along its perimeter to prevent leakage and the introduction of airto the chamber 370. Air can be bled from the chamber 370 by one or moreluers 374 which pass through the main body 308 into the chamber 370 asillustrated in FIG. 6 . As shown in FIG. 6 , the handle 304 can includetwo luers 374, one on each side of the main body 308 (the second luer ishidden from view in FIG. 6 ). The sealed chamber 370 can also havevarious additional seals, such as an actuator rod seal 376 which cansurround the actuator rod 64 where the actuator rod 64 enters the sealedchamber 370, and a shaft seal 378 which can surround the shaft 302 wherethe shaft 302 enters the sealed chamber 370.

Lock line 92 can be extended, retracted, loaded with various amounts oftension, or removed using the lock line handle 310. Likewise, grippingelement lines 90A, 90B can be extended, retracted, loaded with variousamounts of tension, or removed using the gripping element line handle312. Although particular handle 304 including lock line handle 310 andgripping element line handle 312 are shown in FIGS. 5-7 , a variety ofdesigns can be implemented to manipulate the appropriate lines.

Referring to FIGS. 8-19 , for purpose of illustration and notlimitation, handle 3304 can include one or more features described abovewith regard to handles. For example, handle 3304 can include a main body3308, a lock line handle 3310, gripping element line handles 3312A,3312B, and actuator rod handle 3316. The gripping element line handles3312A, 3312B can be used to independently operate each gripping elementline 90A, 90B (FIG. 1 ), respectively. Additional details and exemplarygripping element line handles are provided in U.S. application Ser. No.16/930,241 to Kizuka et al., the entirety of the contents of which isincorporated herein by reference. Actuator rod handle 3316 can operatethe actuator rod 64. Lock line handle 3310 can operate lock line 92.Lock line handle 3310 can be releasably coupled to the main body 3308.Lock line 92 can have a first end portion 92A (FIG. 13A) fixedly coupledto the lock line handle 3310 and a second end portion 92B (FIG. 13A)releasably coupled to the lock line handle 3310. An intermediate portion92C (FIG. 1 ) of the lock line 92 can be configured to engage therelease harness 108 in various arrangements, for example, as shown inFIG. 1 .

As shown in FIGS. 9-11 , for purpose of illustration and not limitation,the handle 3304 and lock line handle 3310 can include a number ofelements to allow the lock line handle 3310 to operate properly,including, for example, operating the lock line 92 and releasing fromthe handle 3304. FIG. 10 shows a perspective view the lock line handle3310 and related elements of the handle 3304; FIG. 11 shows an explodedview. In accordance with the disclosed subject matter, lock line handle3310 can include lock knob 3310A, which can be gripped by a user andpivoted relative handle 3304 to operate the lock line 92 (as describedin greater detail below). The lock knob 3310A can have a pear shapewhich can act as a flag in the unlock position to indicate to a userthat the fixation device 14 is unlocked (see e.g., FIG. 15 ). Althoughshown as a pear shape, lock knob 3310A can have any suitable shapeand/or configuration. Lock knob cap 3310B can be coupled to the lockknob 3310A. Screw cap 3310C can be coupled to shaft 3310D, for examplevia threading or other known means. Lock knob insert 3310E can becoupled lock knob shaft 3310D and lock knob 3310A. For example, aportion of the lock knob insert 3310E can be received within the lockknob 3310A. The pear shape of the lock knob 3310A and the receivedportion of the lock knob insert 3310E can limit relative rotationbetween the lock knob insert 3310E and the lock knob 3310A. Enmeshedgears of the lock knob insert 3310E and the lock knob shaft 3310D canlimit relative rotation between the lock knob insert 3310E and the lockknob shaft 3310D. Furthermore, the gears can permit specific tensions orslack to be set on lock line 92. The tension needed can be differentfrom device to device, but the gears can allow the lock knob 3310A to bealigned in a similar orientation relative the handle 3308 from device todevice. As such, the lock position and the unlock position can beconsistent from device to device. Rotation of the lock knob 3310A cancause rotation of the lock knob insert 3310E, and thereby cause rotationof the lock knob shaft 3310D. The lock knob insert 3310E can include aplurality of detents 3310H and a channel 3310I. Hairpin clip 3310F canbe inserted between the lock knob 3310A and lock knob cap 3310B,proximate the screw cap 3310C to prevent disassembly of the lock linehandle 3310 when in place, and can allow disassembly of the lock linehandle 3310 when removed, for example, in case of malfunction. O-rings3310G can be provided on the shaft 3310D. The O-rings 3310G can be anysuitable O-rings, for example, −010 O-rings.

Handle 3304 can include lock knob volume 3304F, which can receive thelock knob shaft 3310D of the lock line handle 3310. Handle 3304 caninclude a locking system to limit movement of the lock line handle 3310relative the handle 3304 and removal of the lock line handle 3310relative the handle 3304. The lock system can be a latch-detent lock.For example, the latch can include a distal U-lock 3304A and a proximalU-lock 3304B coupled to one another (and collectively referred to as the“U-lock”) and configured to surround lock knob volume 3304F. Theproximal U-lock 3304B can include pin 3304C which can engage detents3310H on the lock knob insert 3310E, when the pin 3304C is insertthrough window 3304G disposed in the lock knob volume 3304F. The distalU-lock 3304A can include a rail 3304T to engage the channel 3310I on thelock knob insert 3310E. The locking system can further include deliverycatheter (“DC”) handle insert 3304D and release slider 3304E, which canbe used to release the lock knob 3310A. The DC handle insert 3304D caninclude an indication, for example, an icon (such as a lock) or writing,to indicate that the DC handle insert 3304D and the release slider 3304Eare intended to lock the lock line handle 3310. For example, and not byway of limitation, release slider 3304E can include a pin 3304R that canengage the proximal U-lock 3304B (for example, through a window in DChandle insert 3304D). Spring 3304N can be supported on pin 3304H of thelock knob volume 3304F, and can bias the latch into the lock position.That is, the spring can bias the latch in a distal direction to causethe pin 3304C to engage the detents 3310H. Engagement of the pin 3304Cwith the detents 3310H can provide feedback, for example, audible and/ortactile, for a user that the lock knob 3310A has reached a specificposition (e.g., lock, unlock, override (also referred to herein as thethird position)). Pin 3304C and detents 3310H can be arranged such thatthe lock knob 3310A will not move from a specific position (e.g., lock,unlock, override), however, a user can move the lock knob 3310A (i.e.,overcome the engagement between the pin 3304C and the detents 3310H) byturning the knob, and without touching the release slider 3304E. Aportion of the distal U-lock 3304A, for example, the rail 3304T on thedistal U-lock 3304A and channel 3310I can be arranged such that the lockline handle 3310 can be removed from the handle 3304 when the distalU-lock 3304A is disengaged from the channel 3310I. For example, a usercan slide the release slider 3304E to disengage the distal U-lock 3304Afrom the channel 3310I and thereby release the lock line handle 3310.For example, sliding the release slider 3304E in the proximal directioncan disengage the rail 3304T on the distal U-lock 3304A from the channel3310I and thereby permit the user to pull the lock line handle 3310 fromthe handle 3308. Although a particular locking system is described, anysuitable locking system can be used to limit movement of the lock knob3304 between the lock, unlock, and override positions, and to preventunintentional removal of the lock line handle 3310 from the handle 3304.

Lock knob volume 3304F can house the spool 33041, about which the lockline 92 can be wrapped to provide tensile load on the lock line 92. Thespool 33041 can be rotationally fixed relative the lock knob shaft3310D, for example, by a keying feature, enmeshed gears, or any suitablemeans. Accordingly, rotation of the lock knob 3310A, which can causerotation of the lock knob shaft 3310D, can thereby cause rotation of thespool 33041 and therefore increase or decrease tensile load on the lockline 92 by way of the lock line 92 spooling or unspooling around thespool 33041. The lock knob volume 3304F can include a dowel pin 3304Q.The first end portion 92A of the lock line 92 can be routed around thedowel pin 3304Q and fin 3304U in the lock knob volume 3304F. This canalign the first end portion 92A of the lock line 92 with the spool 33041and can manage slack in the first end portion 92A of the lock line 92.If slack is not managed, the first end portion 92A of the lock line 92can disengage from the spool 33041. Lock knob volume lid 3304J can closethe lock knob volume 3304F, and can receive a luer fitting, or similar.O-ring retainer 3304K can have a hole through which the lock line 92 canextend. The handle 3304 can include mandrel seal retainer 3304L andmandrel seal 3304M, and O-rings, 3304O, 3304P, which can be, forexample, a −009 O-ring and a −020 O-ring, respectively. Although aspecific arrangement for loading and unloading the lock line 92 isprovided, any suitable means of loading and unloading the lock line 92can be used.

As shown in FIGS. 12 and 13A-13C, for purpose of illustration and notlimitation, the first end portion 92A and the second end portion 92B ofthe lock line 92 can extend through O-ring retainer 3304K. As notedabove, the first end portion 92A can be routed around the dowel pin3304Q and relative fin 3304U, and routed around spool 33041. The firstend portion 92A can further extend within the lock knob shaft 3310D andcan be fixedly coupled to the lock line handle 3310, for example, byscrew cap 3310C. For example, the first end portion 92A can extendthrough the lock knob shaft 3310D and then be wrapped around lock knobshaft 3310D (FIG. 13B). The screw cap 3310C can be coupled to the lockknob shaft 3310D (FIG. 13C) to fixedly couple the first end portion 92Ato the lock line handle 3310. The second end portion 92B can bereleasably coupled to the lock line handle 3310. For example, second endportion 92B can extend into the spool 33041 and between the spool 33041and lock knob shaft 3310D to trap (“sandwich”) the second end portion92B therebetween. Accordingly, when the lock line handle 3310 is coupledwith the handle 3304, the second end portion 92B can be releasablycoupled to the lock line handle 3310, and when the lock line handle 3310is decoupled (released) from the handle 3304, the second end portion 92Bcan be decoupled (released) from the lock line handle 3310. Although,described with specific arrangements for fixedly and releasably couplingthe first end portion 92A and second end portion 92B of the lock line92, respectively, any suitable arraignments for fixedly and releasablycoupling the respective end portions can be used.

The system can be flushed via a port in a fluid management system 3326(FIG. 9 ). For example, flush fluid can enter the lock knob volume 3304Ffrom the distal end through the O-ring retainer 3304K. Duringpreparation of the device, air can exit the device through a luer portin the lock knob volume lid 3304J. When de-airing is complete, a cap3304S can be placed on the luer port. The cap 3304S can be a red cap3304S, which can be easily noticed by a user, however, any suitable capshape and/or color can be used. As noted, O-rings (e.g., 3304P, 3304O)and mandrel seal 3304M can keep hemostasis throughout the procedure.Although fluid flushing and de-airing is described in a particulararrangement, any suitable arrangement can be used for flushing andde-airing.

In operation, the fixation device 14 can be delivered in a lock position(as described above). The lock knob 3310A can be in the lock position,which is shown for example, in FIGS. 8 and 14 . In the lock position,the lock line 92 can have no (or relatively low) tension and the lockknob 3310A can point distally. Spring 3304N can bias distal U-lock 3304Aand proximal U-lock 3304B in a distal direction and therefore bias pin3304C to engage detent 3310H of the lock knob insert 3310E (FIG. 14 ).Although described in a particular arrangement, the lock position caninclude any suitable arrangement.

During a procedure, the user can turn the lock knob 3310A to the unlockposition to apply tension (or relatively higher tension) to the lockline 92. Turning the lock knob 3310A can overcome the engagement of thepin 3304C with detent 3310H. For example, the lock knob 3310A can berotated in a clockwise rotation (as viewed in FIG. 8 ) such that thelock knob 3310A can point upwardly (FIG. 15 ). In such a position, thelock knob 3310A itself can indicate to the user that the fixation device14 is in the unlock position. Rotating the lock knob 3310A can causespool 33041 to rotate (as described above) and can increase tension onthe lock line 92 as the lock line 92 spools around the spool 33041. Asnoted above, increasing tension on lock line 92 can apply a force onharness 108 which can unlock the fixation device 14, as described above.Spring 3304N can bias distal U-lock 3304A and proximal U-lock 3304B in adistal direction and therefore bias pin 3304C to engage detent 3310H ofthe lock knob insert 3310E (FIG. 15 ) and bias the rail 3304T on thedistal U-lock 3304A to engage the channel 3310I of the lock knob insert3310E. The detents 3310H (as well as labeling) can define the lock andunlock positions. A click sound can be made as the pin 3304C engagesdetent 3310H. The detent 3310H can also prevent the lock knob 3310A fromreturning to the lock position (until a user engages the lock knob3310A). Although described in a particular arrangement, the unlockposition can include any suitable arrangement. The user can lock thefixation device 14 by rotating the lock knob 3310A in thecounterclockwise direction (as viewed in FIG. 8 ) to return the lockknob to the lock position, unspool the lock line 92 from spool 33041,and decrease tension on lock line 92. A click sound can be made as thepin 3304C engages detent 3310H. The rail 3304T can remain engaged withthe channel 3310H even as the handle moves between the lock, unlock, andthird position. Although a particular method of operating the lock linehandle is described, and suitable method of operating the lock linehandle can be used to increase or decrease tension on lock line 92.

The lock knob 3310A can be rotated beyond the unlock position (see e.g.,FIG. 16 ), to a third position, and to thereby further increase tensionon the lock line 92. This can be useful during certain procedures toensure that the fixation device 14 properly locks. Additional detents3310H can be provided to engage the pin 3304C and hold the lock knob3310A in the third position or further rotated positions. The rail 3304Tcan remain engaged with the channel 3310H even as the handle movesbetween the lock, unlock, and third positions. Although described in aparticular arrangement, the third position, and any further positions,can include any suitable arrangement.

Before the fixation device 14 can be deployed from the delivery device300, the lock line 92 must be decoupled from the fixation device 14. Toremove the lock line 92, the user can ensure that the lock knob 3310A isin the lock position. The user can retract the release slider 3304E(i.e., the release slider can be pulled in the proximal direction). Thiscan pull the proximal U-lock 3304B (for example via pin 3304R) and thedistal U-lock 3304A in a proximal direction (FIGS. 17A and 17B), whichcan disengage the rail 3304T of the distal U-lock 3304A from channel3310I. The user can pull the lock line handle 3310 off the handle 3304(FIG. 18 ). Withdrawing the lock line handle 3310 can release the secondend portion 92B of lock line 92 from between the spool 33041 and lockknob shaft 3310D, while the first end portion 92A remains fixed to thelock line handle 3310. Accordingly, withdrawing the lock line handle3310 pulls one end portion of the lock line 92 (i.e., first end portion92A), while the other end portion (i.e., the second end portion 92B) isfree to travel distally along the length of the shaft 302, through thefixation device 14, and proximally along the length of the shaft 302.Therefore, pulling the lock line handle 3310 away from the handle 3304with withdraw the lock line from the delivery system 300 and fixationdevice 14.

If the first end portion 92A of the lock line 92 becomes stuck, the usercan disassemble the lock line handle 3310 (FIG. 19 ). For example, theuser can remove hairpin clip 3310F and remove the lock knob 3310A andlock knob insert 3310E from the lock knob shaft 3310D. The user can thenunscrew screw cap 3310C from the lock knob shaft 3310D. This can provideaccess the first end portion 92A. The user can pull the second endportion 92B of the lock line 92 to pull to free the “stuck” first endportion 92A. Although a particular method of disassembling the handle isdescribed, any suitable method for disassembling the handle can be used.

In accordance with the disclosed subject matter, a variety of lock linehandle designs can be used to operate, release, and retract the lockline 92. For example, and with reference to FIG. 20-21C for purpose ofillustration and not limitation, handle 2304 can have any of thefeatures described herein above related to handles. For example, handle2304 can include main body 2308, lock line handle 2310, gripping elementline handle 2312, and actuator rod handle 2316. Lock line handle 2310can include slider 2330, which can be, for example, a thumb slide. Lockline 92 (not shown) can extend from slider 2330 to the harness 108 offixation device 14. The slider 2330 can be moveable between a lock(e.g., forward, distal) position (FIG. 21A) and an unlock (e.g.,retracted, proximal) position (FIG. 21C). Slider 2330 can be slidablebetween the lock and unlock positions (FIG. 21B). Moving slider 2330from the lock position toward the unlock position can increase tensionon the lock line 92, and therefore apply a force on harness 108 whichunlocks the fixation device 14, as described above. Moving slider 2330from the unlock position toward the lock position can reduce tension onthe lock line 92, and therefore reduce the force on harness 108 whichlocks the fixation device 14, as described above. Slider 2330 caninclude a lock assembly, for example, a latch-detent lock, to audiblyand/or tactically indicate to the user that the slider 2330 has reachedthe lock or unlock position. For example, slider 2330 can include latch2331, which can be received in detent 2332A in the lock position anddetent 2332B in the unlock position. Spring 2334 can ensure that latch2331 engages detents 2332A, 2332B as slider 2330 slides relative thelock and unlock positions. Slider 2330 can include an ergonomic shapefor receiving a user's thumb or finger to push slider 2330 and releaselatch 2331 from detents 2332A, 2332B. Additionally, slider 2330 caninclude an override mechanism to selectively prevent actuation of theslider 2330 from the unlock position to a third position. Actuating theslider 2330 from the unlock position to the third position can increasetension on the lock line 92 beyond the tension on the lock line 92 whenthe lock line handle 2310 is in the unlock position. This third positioncan be useful during troubleshooting. The override mechanism can be alatch-detent lock, pin, push button, slide or the like.

Referring to FIGS. 22A-22C, for purpose of illustration and notlimitation, slider 2330 can be releasably coupled to the main body 2308.The lock line 92 can include a first portion fixedly coupled to theslider 2330 and a second portion releasably coupled to the slider 2330.The lock line 92 can further have an intermediate portion that extendsto and is releasably coupled to the harness 108 of fixation device 14disposed proximate the distal end of the shaft 302. Accordingly, torelease the harness 108, the second portion of lock line 92 can bereleased from the slider 2330, and the slider 2330 can be released andpulled away from handle 304, thereby withdrawing the lock line 92. Asshown in FIG. 22A, slider 2330A slides away from handle 304 to deploy.Slider 2330A can include release assembly 2340A to prevent unwantedrelease. Release assembly 2340A can include, for example, a slide 2342Aand catch 2341A. As shown in FIG. 22B, slider 2330B rotates off handle304 to deploy. Slider 2330B can include release assembly 2340B toprevent unwanted release. Release assembly 2340B can include, forexample, a catch 2341B. As shown in FIG. 22C, slider 2330C is releasedby pinch button release assembly 2340C. Pinch button release assembly2340 can move catch 2341C and thereby release slider 2330C. The processof releasing the slider 2330 (e.g., 2330A, 2330B, 2330C) cansimultaneously release the second portion of the lock line 92. Theslider 2330 (e.g., 2330A, 2330B, 2330C) can then be withdrawn, and canlikewise withdraw lock line 92 because the first portion remains coupledto the slider 2330 (e.g., 2330A, 2330B, 2330C).

Although particular lock line handles are described herein, thisdisclosure contemplates any suitable lock line handle. For example, andwith reference to FIG. 23 for purpose of illustration and notlimitation, handle 4304 can have any of the features described hereinabove related to handles. For example, handle 4304 can include the lockline handle 4310. Lock line handle 4310 can have a T-shape, or similarshape for ergonomic grasping. Although shown as a T-shape, any ergonomicshape which can allow a user to easily apply a significant amount ofproximal force on handle 4310 is suitable. Lock line handle 4310 can bein a distal position (FIG. 23 ) to lock the fixation device 16, and lockline handle 4310 can slide relative handle 4304, for example,proximally, to lock the fixation device. With reference to FIG. 24 forpurpose of illustration and not limitation, handle 5304 can have any ofthe features described herein above related to handles. For example,lock line handle 5314 can be configured to pivot relative the handle toactuate between the lock position and the unlock position. For example,lock line handle can be in a distal position (not shown) to lock thefixation device 16 and can rotated relative handle 5304 to a proximalposition to unlock the fixation device 16 (FIG. 24 ). Referring to FIGS.25A-26B for purpose of illustration and not limitation, handle 6304 canhave any of the features described herein above related to handles. Lockline handle 6310 can have a pear shape, as described above. FIGS. 25Aand 25B show the lock line handle 6310 in the lock position and unlockposition, respectively. As noted above, the lock line handle can act asa flag in the unlock position to indicate to a user that the fixationdevice 14 is unlocked. FIGS. 26A and 26B show the lock line handle inthe unlock position and the third position, respectively.

Although particular release assemblies for the lock line handle aredescribed herein, this disclosure contemplates any suitable releaseassembly for the lock line handle. For example, and with reference toFIGS. 27A-28B, the release assembly can be a push-button release. FIG.27A shows the lock line handle 6310 with the push button 6310A pressedand the lock line handle 6310 ready for removal from the handle 3604.FIG. 27B shows the lock line handle 6310 removed from the handle 6304.FIG. 28A shows a cut-away view of the push-button release 6310A in thelocked position (i.e., preventing release of the lock line handle 6310).FIG. 28B shows a cut-away view of the push-button release 6310A in theunlock position (i.e., allowing release of the lock line handle). Asshown, when push bottom release 6310A is pressed downwardly (arrow6310C), flaps 6310B can extend outwardly (arrows 6310D), and releaselock line handle 6310 from handle 6304.

Although described particularly above, in accordance with the disclosedsubject matter, the lock line can be coupled to the lock line handle inany suitable manner. For example, and with reference to FIGS. 29A and29B, the lock line handle 6310 can include a spool 6310E for receivingthe lock line 92. When the lock line handle is rotated, the lock line 92can rotate around the spool 6310E. A first end portion of the lock line92 can extend through a slot 6310H and can be attached to the shaft6310G. A second end portion of the lock line can loop around spool6310E, go through a hole 63101 in the spool 6310E, and can be trapped bythe shaft 6310G. This loop can ensure the line does not slip duringtensioning. During deployment, the shaft 6310G can be removed, asdescribed above, which can free the second end portion of the lock line92. Continuing to pull the shaft 6310G can pull the entire length of thelock line 92 out of the delivery system 300. With reference to FIG. 30 ,for purpose of illustration and not limitation, the first portion of thelock line can be fixedly coupled to the lock line handle 6310 by aswivel head set screw 6310J.

Although particular lock assemblies for the lock line handle aredescribed herein, this disclosure contemplates any suitable lockassembly. Referring to FIGS. 31A-33 for purpose of illustration and notlimitation, an exemplary lock line handle 7310 is provided. The lockline handle 7310 can include a lock assembly, for example, includingactivation lever 7310A for actuating a latch-detent lock. Thelatch-detent lock can prevent movement of the lock line handle betweenthe lock and unlock positions unless the activation lever is actuated.The lock assembly can also prevent (or allow) movement between theunlock position and the third position. For example, the latch-detentlock can include a pin 7310B and detent 7310C disposed in track 7310D.The pin 7310B can engage the beginning or end of track (see e.g., FIG.32A) or detent 7310B (see e.g., FIG. 32C). The lever of the lockassembly can control a latch-detent lock. FIG. 32A shows the lock linehandle in the locked position with a latch-detent lock engaged. FIG. 32Bshows the lock line handle in the unlock position with a latch-detentlock engaged. FIG. 32C shows a latch-detent lock disengaged to permitmovement of the lock line handle 7310. Although the lock assemblyincludes a lever 7310A, the lock assembly can include any suitableactivation feature, such as a button or switch. The lock line handle7310 can also include a safety feature, for example a pin 7310E, toprevent premature actuation of the release assembly. FIG. 33 shows a pin7310E that needs to be removed before the push-button release 7310F canbe pressed to release the lock line handle 7310.

Referring to FIG. 34 , for purpose of illustration and not limitation,medical delivery system 3 including a steerable guide system 1 isprovided. The steerable guide system 1 can include multiple steerablecatheter components. For example, and not limitation, steerable guidesystem 1 can include an outer guide catheter 1000, having a proximal end1014 and a distal end 1016, and an inner guide catheter 1020, having aproximal end 1024 and a distal end 1026, wherein the inner guidecatheter 1020 is positioned coaxially within the outer guide catheter1000, as shown. In addition, a hemostatic valve 1090 can be disposedwithin handle 1056 or external to handle 1056 as shown to provideleak-free sealing with or without the inner guide catheter 1020 inplace. The distal ends 1016, 1026 of catheter 1000, 1020, respectively,are sized to be passable to a body cavity, typically through a bodylumen such as a vascular lumen.

Manipulation of the guide catheter 1000, 1020 can be achieved with theuse of handles 1056, 1057 attached to the proximal ends of the catheter1000, 1020. As shown, handle 1056 is attached to the proximal end 1014of outer guide catheter 1000 and handle 1057 is attached to the proximalend 1024 of inner guide catheter 1020. Inner guide catheter 1020 isinserted through handle 1056 and is positioned coaxially within outerguide catheter 1000.

The delivery catheter 300 can be inserted though handle 1057 and can bepositioned coaxially within inner guide catheter 1020 and outer guidecatheter 1000. The delivery catheter 300 includes a shaft 302, having aproximal end 322 and a distal end 324, and a handle 304 attached to theproximal end 322. A fixation device 104 can be removably coupled to thedistal end 324 for deliver to a site within the patient

The outer guide catheter 1000 and/or the inner guide catheter 1020 canbe precurved and/or have steering mechanisms to position the distal ends1016, 1026 in desired directions. Precurvature or steering of the outerguide catheter 1000 can direct the distal end 1016 in a first directionto create a primary curve while precurvature and/or steering of theinner guide catheter 1020 can direct distal end 1026 in a seconddirection, different from the first, to create a secondary curve.Together, the primary and secondary curves can form a compound curve.Furthermore, advancement of the entire interventional system 3 or theinner guide catheter 1020 (relative to the outer guide catheter 1000)can further direct the distal end 1026 of the inner guide catheter 1020toward a desired position. Advancement of the delivery catheter 300through the coaxial guide catheters 1000, 1020 can guide the deliverycatheter 300 through the compound curve toward a desired direction,usually in a direction which will position the fixation device 104 in adesired location in the body.

FIG. 35 is an enlarged view of the controls of a medical delivery system3 in accordance with the disclosed subject matter. Handles 1056, 1057 ofthe steerable guide system 1 are shown. Each handle 1056, 1057 includesa set of steering knobs 1300 a, 1300 b, as shown. Manipulation of guidecatheter 1000 and 1020 can be achieved with the use of the steeringknobs 1300 a, 1300 b attached to the proximal ends of the catheters1000, 1020. Further details of exemplary delivery systems are disclosedin the patents and published applications incorporated by referenceherein. Alternative handles and/or controls likewise are contemplated inaccordance with the disclosed subject matter.

While the embodiments disclosed herein utilize a push-to-open,pull-to-close mechanism for opening and closing arms it should beunderstood that other suitable mechanisms can be used, such as apull-to-open, push-to-close mechanism. A closure bias can be included,for example using a compliant mechanism such as a linear spring, helicalspring, or leaf spring. Other actuation elements can be used fordeployment of the gripper elements.

While the disclosed subject matter is described herein in terms ofcertain preferred embodiments for purpose of illustration and notlimitation, those skilled in the art will recognize that variousmodifications and improvements can be made to the disclosed subjectmatter without departing from the scope thereof. Moreover, althoughindividual features of one embodiment of the disclosed subject mattercan be discussed herein or shown in the drawings of one embodiment andnot in other embodiments, it should be readily apparent that individualfeatures of one embodiment can be combined with one or more features ofanother embodiment or features from a plurality of embodiments.

In addition to the specific embodiments claimed below, the disclosedsubject matter is also directed to other embodiments having any otherpossible combination of the dependent features claimed below and thosedisclosed above. As such, the particular features presented in thedependent claims and disclosed above can be combined with each other inother possible combinations. Thus, the foregoing description of specificembodiments of the disclosed subject matter has been presented forpurposes of illustration and description. It is not intended to beexhaustive or to limit the disclosed subject matter to those embodimentsdisclosed.

It will be apparent to those skilled in the art that variousmodifications and variations can be made in the method and system of thedisclosed subject matter without departing from the spirit or scope ofthe disclosed subject matter. Thus, it is intended that the disclosedsubject matter include modifications and variations that are within thescope of the appended claims and their equivalents.

1-22. (canceled)
 23. A medical device delivery system for delivering amedical implant, comprising: a catheter having a proximal end portionand a distal end portion; a handle coupled to the proximal end portionof the catheter; a lock line handle releasably coupled to the handle; alock line having a first end portion fixedly coupled to the lock linehandle and a second end portion releasably coupled to the lock linehandle by a releasable lock, wherein the second end portion isconfigured to be released from the lock line handle by release of thelock line handle from the handle; and a release assembly comprising arelease mechanism configured to release the lock line handle from thehandle, the release mechanism disposed on and at least partially exposedoutside the handle separate from the lock line handle.
 24. The medicaldevice delivery system of claim 23, wherein the release mechanism is aslide release, a clip, a snap fit, or a button-release.
 25. The medicaldevice delivery system of claim 24, wherein the release mechanism is abutton-release comprising at least one tab configured to be depressed todecouple the lock line handle from the handle.
 26. The medical devicedelivery system of claim 23, wherein the release assembly comprises afirst lock member and a second lock member releasably coupled to thefirst lock member, wherein the release mechanism is configured touncouple the first lock member and the second lock member.
 27. Themedical device delivery system of claim 23, wherein the lock line handlecomprises a spool to wind the lock line.
 28. The medical device deliverysystem of claim 27, wherein the lock line handle further comprises ashaft releasably coupled with the spool; the second end portion of thelock line is captured between the spool and the shaft; and release ofthe lock line handle from the handle allows the second end portion ofthe lock line to be released from between the spool and the shaft. 29.The medical device delivery system of claim 23, wherein: the lock linehandle is configured to be moved between a lock position and an unlockposition; and further wherein actuating from the lock position towardthe unlocked position increases a tension on the lock line, andactuating the lock line handle from the unlock position toward the lockposition decreases the tension on the lock line.
 30. The medical devicedelivery system of claim 29, wherein each of increasing and decreasingthe tension on the lock line is achieved by rotating the lock linehandle.
 31. The medical device delivery system of claim 29, furthercomprising a lock assembly configured to selectively secure the lockline handle in each of the lock position and unlock position.
 32. Themedical device delivery system of claim 31, wherein the lock assemblycomprises at least one of audible and tactile feedback upon locking. 33.The medical device delivery system of claim 31, wherein the lockassembly comprises a latch-detent lock.
 34. The medical device deliverysystem of claim 33, wherein the lock assembly includes: a plurality ofdetents along a surface of the lock line handle, and a spring-biased pinto engage with the plurality of detents.
 35. The medical device deliverysystem of claim 31, wherein the lock line handle is actuatable from theunlock position toward a third position to further increase tension onthe lock line beyond the tension on the lock line in the unlockposition.
 36. The medical device delivery system of claim 35, furthercomprising an override mechanism to selectively prevent actuation of thelock line handle from the unlock position to the third position.
 37. Themedical device delivery system of claim 29, wherein the lock line handlefurther comprises a gear set to apply the tension on the lock line. 38.The medical device delivery system of claim 29, wherein the lock linehandle is configured to translate linearly relative the handle toactuate between the lock position and the unlock position.
 39. Themedical device delivery system of claim 38, wherein the lock line handleis a T-shape, a thumb slide, or a pear shape.
 40. The medical devicedelivery system of claim 23, wherein the catheter defines at least onelumen extending between the proximal end portion and the distal endportion; and the medical device delivery system further comprises ashaft having a proximal end portion and a distal end portion, andextending through the at least one lumen, the medical implant releasablycoupled the distal end portion of the shaft.
 41. The medical devicedelivery system of claim 23, wherein the medical implant comprises animplantable fixation device including a first arm moveable between afirst position and a second position; a second arm moveable between afirst position and a second position; wherein when the lock line handleis in a lock position the first arm and the second arm are restricted atleast from moving from the respective first positions toward therespective second positions, and further wherein when the lock linehandle is in an unlock position the first arm and second arm can bemoved freely between the respective first positions and respectivesecond positions.
 42. The medical device delivery system of claim 31,wherein when the lock line handle is in the lock position, the first armand the second arm can each move from the respective second positionstoward the respective first positions.